Heart Attack and Unstable Angina

Overview

What is a heart attack?

A heart attack occurs
when blood flow to the heart is blocked. Without blood and the oxygen it
carries, part of the heart starts to die. A heart attack doesn't have to be
deadly. Quick treatment can restore blood flow to the heart and save your
life.

Your doctor might call a heart attack a myocardial
infarction, or MI. Your doctor might also use the term
acute coronary syndrome for your heart attack or
unstable angina.

What is angina, and why is unstable angina a concern?

Angina (say "ANN-juh-nuh" or "ann-JY-nuh") is a type of chest pain or
discomfort that occurs when there is not enough blood flow to the heart. Angina
can be dangerous. So it is important to pay attention to your symptoms, know what
is typical for you, learn how to control it, and know when to call for help.

Symptoms of angina include chest pain or pressure, or a strange feeling in the chest. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.

There are two types of angina:

Stable angina has a typical
pattern. You can likely predict when it will happen. It happens when your heart is working harder and needs more oxygen,
such as during exercise. Your symptoms go away when you rest.

Unstable angina is unexpected, and
resting or taking nitroglycerin may not help. Your doctor will probably
diagnose unstable angina if you are having symptoms for the first time or if
your symptoms are getting worse, lasting longer, happening more often, or happening
at rest.

Unstable angina is a warning sign that a heart attack may
happen soon, so it requires treatment right away. But if you have any symptoms of angina, see your doctor.

What causes a heart attack?

Heart attacks happen
when blood flow to the heart is blocked. This usually occurs because fatty
deposits called
plaque have built up inside the
coronary arteries, which supply blood to the heart. If a plaque breaks open, the
body tries to fix it by forming a clot around it. The clot can block the
artery, preventing the flow of blood and oxygen to the heart.

This process of plaque buildup in
the coronary arteries is called coronary artery disease, or CAD. In many
people, plaque begins to form in childhood and gradually builds up over a
lifetime. Plaque deposits may limit blood flow to the heart and cause angina.
But too often, a heart attack is the first sign of CAD.

Things
like intense exercise, sudden strong emotion, or illegal drug use (such as a
stimulant, like cocaine) can trigger a heart attack. But in many cases, there
is no clear reason why heart attacks occur when they do.

What are the symptoms?

Symptoms of a heart attack include:

Chest pain or pressure, or a strange feeling in the chest.

Sweating.

Shortness of breath.

Nausea or vomiting.

Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.

Lightheadedness or sudden weakness.

A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Here are some other ways to describe the pain from heart attack:

Many people describe the pain as discomfort, pressure,
squeezing, or heaviness in the chest.

People often put their fist to their chest when they describe
the pain.

The pain may spread down the left shoulder and arm and to
other areas, such as the back, jaw, neck, or right arm.

Unstable angina has symptoms similar to a heart attack.

What should you do if you think you are having a heart attack?

If you have symptoms of a heart attack, act fast. Quick
treatment could save your life.

If
your doctor has prescribed nitroglycerin for angina:

Take 1 dose of nitroglycerin and wait 5 minutes.

If your symptoms don't improve or if they get worse,
call 911 or other emergency services. Describe your symptoms, and say that you
could be having a heart attack.

Stay on the phone. The emergency operator will tell you what
to do. The operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Aspirin helps keep blood from clotting, so it may help you
survive a heart attack.

Wait for an ambulance. Do not try to drive yourself.

If you do not have nitroglycerin:

Call 911 or other emergency services now. Describe your symptoms, and say that you could
be having a heart attack.

Stay on the phone. The emergency operator will tell you what
to do. The operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Aspirin helps keep blood from clotting, so it may help you
survive a heart attack.

Wait for an ambulance. Do not try to drive yourself.

The best choice is to go to the hospital in an ambulance.
The paramedics can begin lifesaving treatments even before you arrive at the
hospital. If you cannot reach emergency services, have someone drive you to the
hospital right away. Do not drive yourself unless you have absolutely no other
choice.

If you think you are having unstable angina but you are
not sure, follow the steps listed above. Unstable angina can lead to a heart
attack or death, so you need to have it checked right away.

How is a heart attack treated?

If you go to the
hospital in an ambulance, treatment will be started right away to restore blood
flow and limit damage to the heart. You may be given:

Blood tests, including tests to see whether cardiac
enzymes are high. Having these enzymes in the blood is
usually a sign that the heart has been damaged.

Cardiac catheterization, if the other tests show that you may be having a heart attack. This test shows which arteries are
blocked and how your heart is working.

If cardiac catheterization
shows that an artery is blocked, a doctor may do
angioplasty right away to help blood flow through the artery. Or a doctor may do
emergency
bypass surgery to redirect blood around the blocked
artery.

After these treatments, you will take medicines to help prevent another heart attack. Take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine, you might raise your risk of having another heart attack.

After you have had a heart attack, the chance that
you will have another one is higher. Taking part in a
cardiac rehab program helps lower this risk. A cardiac
rehab program is designed for you and supervised by doctors and other
specialists. It can help you learn how to eat a balanced diet and exercise
safely.

It is common to
feel worried and afraid after a heart attack. But if you are feeling very sad
or hopeless, ask your doctor about treatment. Getting treatment for depression
may help you recover from a heart attack.

Can you prevent a heart attack?

Heart attacks are
usually the result of heart disease, so taking steps to delay or reverse
coronary artery disease can help prevent a heart attack. Heart disease is
a leading cause of death for both men and women, so these steps
are important for everyone.

To improve your heart health:

Don't smoke, and avoid secondhand smoke. Quitting smoking can
quickly reduce the risk of another heart attack or death.

Eat a heart-healthy diet that includes plenty of fish, fruits,
vegetables, beans, high-fiber grains and breads, and olive oil.

Get regular exercise. Your doctor can suggest a safe level of
exercise for you.

Stay at a healthy weight. Lose weight if you need to.

Manage other health problems such as diabetes, high cholesterol, and high blood pressure.

Lower your stress level. Stress can damage your heart.

Take a daily aspirin if your doctor advises it.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health problems.

Cause

A heart attack or unstable angina is caused by
sudden narrowing or blockage of a coronary artery. This blockage keeps blood and oxygen from getting to the heart.

This blockage happens because of a problem called atherosclerosis, or hardening of the arteries. This is a process where fatty deposits called plaque
build up inside arteries. Arteries are the blood vessels that carry
oxygen-rich blood throughout your body. When atherosclerosis happens in the coronary arteries, it leads to heart disease.

If the plaque breaks apart, it can cause a heart attack or unstable angina. A tear or rupture in the plaque tells the body to repair the injured artery lining, much as the body might heal a cut on the skin. A blood clot forms to seal the area. The blood clot can completely block blood flow to the heart muscle.

With a heart attack, lack of blood flow causes the heart's muscle cells to start to die. With unstable angina, the blood flow is not completely blocked by the blood clot. But a heart attack may soon follow, because
the blood clot can quickly grow and block the artery.

A stent in a coronary artery can also become blocked and cause a heart attack. The stent might become narrow again if scar tissue grows after the stent is placed. And a blood clot could get stuck in the stent and block blood flow to the heart.

Heart attack triggers

In most cases, there are no
clear reasons why heart attacks occur when they do. But sometimes your body
releases adrenaline and other hormones into the bloodstream in response to
intense emotions such as anger, fear, and the "fight or flight" impulse. Heavy
physical exercise, emotional stress, lack of sleep, and overeating can also
trigger this response. Adrenaline increases blood pressure and heart rate and
can cause coronary arteries to constrict, which may cause an unstable plaque to
rupture.

Rare causes

In rare cases, the coronary artery spasms and contracts,
obstructing blood flow and causing chest pain. If severe, the spasm can
completely block blood flow and cause a heart attack. Most of the time in these
cases, atherosclerosis is also involved, although sometimes the arteries are
clear. Cocaine, cold weather, emotional stress, and other things can cause
these spasms. But in many other cases, it is not known what triggers the
spasm.

Another rare cause of heart attack can be a sudden tear in the coronary artery, or spontaneous coronary artery dissection. In this case, the coronary artery tears without a known cause.

Unstable angina

Call 911 or other emergency services immediately if you think you are having a heart attack or unstable angina.

People who have unstable angina often describe
their symptoms as:

Starting within the past 2 months and becoming more
severe.

Limiting their physical activity.

Suddenly becoming more frequent, severe, or longer-lasting or
being brought on by less exertion than before.

Occurring at rest with no obvious exertion or stress. Some say these symptoms may wake
you up.

Not responding to rest or nitroglycerin.

The symptoms of stable angina are different from those of
unstable angina. Stable angina occurs at predictable times with a specific
amount of exertion or activity and may continue without much change for years.
It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than
5 minutes.

Women's symptoms

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Women are more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack or not wanting to bother others. But it is better to be safe than sorry. If you have symptoms of a possible heart attack, call for help.
When you get to the hospital, don't be afraid to speak up for what you need. To get the tests and care that you need, be sure your doctors know that you think you might be having a heart attack.

Other ways to describe chest pain

People who are having a heart attack
often describe their chest pain in various ways. The pain:

May feel like pressure, heaviness, weight, tightness, squeezing,
discomfort, burning, a sharp ache (less common), or a dull ache. People often
put a fist to the chest when describing the pain.

May radiate from the chest down the left shoulder and arm (the
most common site) and also to other areas, including the left shoulder, middle
of the back, upper portion of the abdomen, right arm, neck, and jaw.

May be diffuse—the exact location of the pain is usually
difficult to point out.

Is not made worse by taking a deep breath or pressing on the
chest.

Usually begins at a low level, then gradually increases over
several minutes to a peak. The discomfort may come and go. Chest pain that
reaches its maximum intensity within seconds may represent another serious
problem, such as an
aortic dissection.

It is possible to have a "silent heart attack" without any symptoms, but
this is rare.

Your doctor can help you find out your risk of having a heart attack. Knowing your risk is just the beginning for you and your doctor. Knowing your risk can help you and your doctor talk about whether you need to lower your risk. Together, you can decide what treatment is best for you.

Things that increase your risk of a heart attack include:

High cholesterol.

High blood pressure.

Diabetes.

Smoking.

A family history of early heart disease. Early heart disease means you have a male family member who was diagnosed before age 55 or a female family member who was diagnosed before age 65.

Your age, sex, and race can also raise your risk. For example, your risk increases as you get older.

Women and heart disease

Women have unique risk factors for heart disease, including hormone therapy and pregnancy-related problems. These things can raise a woman's risk for a heart attack or stroke.

NSAIDs

Most
nonsteroidal anti-inflammatory drugs (NSAIDs), which
are used to relieve pain and fever and reduce swelling and inflammation, may
increase the risk of heart attack. This risk is greater if you take NSAIDs at
higher doses or for long periods of time. People who are older than 65 or who
have existing heart, stomach, or intestinal disease are more likely to have
problems. Be safe with medicines. Read and follow all instructions on the label.

Aspirin, unlike other NSAIDs, has been shown to reduce
the risk of heart attack and stroke. But it also carries the risks of serious
stomach and intestinal bleeding as well as skin reactions. Regular use of other
NSAIDs, such as ibuprofen, may make aspirin less effective in preventing heart
attack and stroke.

For information on how to prevent a heart attack, see the Prevention section of this topic.

When to Call a Doctor

Do not wait if you think you are having a heart attack. Getting help fast can save your life. Even if you're not sure it's a heart attack, have it checked out.

Call 911 or other emergency services immediately if you have symptoms of a heart attack. These may include:

Chest pain or pressure, or a strange feeling in the chest.

Sweating.

Shortness of breath.

Nausea or vomiting.

Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.

Lightheadedness or sudden weakness.

A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.

Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Why wait for an ambulance?

By calling
911 and taking an ambulance to the
hospital, you may be able to start treatment before you arrive at the hospital.
If any complications occur along the way, ambulance personnel are trained to
evaluate and treat them.

If an ambulance is not readily
available, have someone else drive you to the emergency room. Do not drive
yourself to the hospital.

CPR

If you witness a person become
unconscious, call 911 or other emergency
services and start CPR (cardiopulmonary resuscitation). The emergency operator
can coach you on how to perform CPR.

Exams and Tests

Emergency testing for a heart attack

After you
call 911 for a
heart attack, paramedics will quickly assess your
heart rate, blood pressure, and breathing rate. They also will place electrodes on your
chest for an
electrocardiogram (EKG, ECG) to check your heart's electrical activity.

When you arrive at
the hospital, the emergency room doctor will take your history and do a
physical exam, and a more complete ECG will be done. A technician will draw blood to test for
cardiac enzymes, which are released into the
bloodstream when heart cells die.

If your tests show that you are at
risk of having or are having a
heart attack, your doctor will probably recommend that
you have
cardiac catheterization. The doctor can then see whether your coronary arteries are blocked and how your
heart functions.

If your tests
do not clearly show a heart attack or unstable
angina and you do not have other risk factors (such as a previous heart
attack), you will probably have other tests. These may include a cardiac perfusion
scan or SPECT imaging test.

If your tests do not show signs of a heart attack but
your doctor thinks you have unstable angina and may be in danger of having a
heart attack, you will be admitted to the hospital.

Testing after a heart attack

From 2 to 3 days
after a heart attack or after being admitted to the hospital for unstable
angina, you may have more tests. (Even though you may have had some of these tests while you were in the emergency room, you may have some of them again.)

Doctors use these tests to see how well your heart is working and to
find out whether undamaged areas of the heart are still receiving enough
blood flow.

These tests may include:

Echocardiogram (echo). An echo is used to find out several things about the heart, including its size, thickness, movement, and blood flow.

Stress electrocardiogram (such as
treadmill testing). This test compares your ECG while you are at rest to
your ECG after your heart has been stressed, either through physical exercise
(treadmill or bike) or by using a medicine.

Stress echocardiogram. A stress
echocardiogram can show whether you may have reduced blood flow to the
heart.

Cardiac perfusion scan. This test is used to estimate
the amount of blood reaching the heart muscle during rest and exercise.

Cardiac catheterization. In this test, a dye
(contrast material) is injected into the coronary arteries to evaluate your
heart and coronary arteries.

Treatment Overview

Do not wait if you think you are having a heart attack. Getting help fast can save your life.

Emergency treatment gets blood flowing back to the heart. This treatment is similar for unstable angina and
heart attack.

For unstable angina, treatment prevents a heart attack.

For a heart
attack, treatment limits the damage to your heart.

Ambulance and emergency room

Treatment begins in the ambulance and emergency room. The goal of your health care team will
be to prevent permanent heart muscle damage by restoring blood flow to your
heart as quickly as possible. Treatment includes:

Nitroglycerin. It opens up the arteries of the heart to help blood flow back to the heart.

Beta-blockers. These drugs lower the heart rate, blood pressure, and the workload of the heart.

You also will receive medicines to stop blood clots. These are given to prevent blood clots from getting bigger so blood can flow to the heart. Some medicines will break up blood clots to increase blood flow. You might be given:

Angioplasty or surgery

Angioplasty. Doctors try to do angioplasty as soon as possible after a heart attack. Angioplasty might be done for unstable angina, especially if there is a high risk of a heart attack.

Angioplasty gets blood flowing to the heart. It opens a coronary artery that was narrowed or blocked during the heart attack.

But angioplasty is not available in all hospitals. Sometimes an ambulance will take a person to a hospital that provides angioplasty, even if that hospital is farther away. If a person is at a hospital that does not do angioplasty, he or she might be moved to another hospital where angioplasty is available.

If you are treated at a hospital that has proper
equipment and staff, you may be taken to the
cardiac catheterization lab. You will have cardiac catheterization, also called a coronary angiogram. Your doctor will
check your coronary arteries to see if angioplasty is right for you.

Bypass surgery. If angioplasty is not
right for you, emergency coronary artery bypass surgery may be done. For example, bypass surgery might be a better option because of the location of the blockage or because of numerous
blockages.

Other treatment in the hospital

After a heart attack, you will stay in the hospital for at
least a few days. Your doctors and nurses will watch you closely. They will check your heart rate and rhythm, blood pressure, and medicines to make sure you don't have serious complications.

Your doctors will start you on medicines that lower your risk of having another heart attack or having complications and that help you live longer after your heart attack. You may have already been taking some of these medicines. They include:

You will take these medicines for a long time, maybe the rest of your life.

After you go home from the hospital, take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine, you might raise your risk of having another heart attack.

Cardiac rehabilitation

Cardiac rehabilitation might be started in the hospital or soon after you go home. It's an important part of your recovery after a heart attack. Cardiac rehab teaches you how to be more active and make lifestyle changes that can lead to a stronger heart and better health. Cardiac rehab can help you feel better and reduce your risk of future heart problems.

If you don't do a cardiac rehab program, you will still need to learn about
lifestyle changes that can lower your risk of another heart attack. These changes include quitting smoking, eating heart-healthy foods,
and being active.

Quitting smoking is part of cardiac rehab. Medicines and counseling can help you quit for good. People who continue to smoke after a
heart attack are much more likely than nonsmokers to have another heart attack.
When a person quits, the risk of another heart attack decreases a lot in the first
year after stopping smoking.

Go to your doctor visits

Your doctor will
want to closely watch your health after a heart attack. Be sure to keep all your
appointments. Tell your doctor about any changes in your condition, such as
changes in chest pain, weight gain or loss, shortness of breath with or without
exercise, and feelings of depression.

Prevention

You can help prevent
a heart attack by taking steps that slow or prevent coronary artery disease—the main risk factor for a heart attack. A heart-healthy lifestyle is important for everyone, not just for people who have health problems. It can help you keep your body healthy and lower your risk of a heart attack.

Make lifestyle changes

Quit smoking. It may be the best thing you can do to
prevent heart disease. You can start lowering your risk right away by quitting smoking. Also,
avoid secondhand smoke.

Exercise. Being active is good for your heart and blood vessels, as well as the rest of your body. Being active helps lower your risk of health problems. And it helps you feel good. Try to exercise for at least 30
minutes on most, if not all, days of the week. Talk to your doctor before
starting an exercise program.

Reach and stay at a healthy weight. A healthy weight is a weight that lowers your risk for health problems including heart disease. Eating heart-healthy foods and being active can help you manage your weight and lower your risk.

Manage other health problems

Manage other health problems that raise your risk for a heart attack. These include diabetes, high blood pressure, and high cholesterol. A heart-healthy lifestyle can help you manage these problems. But you may also need to take medicine.

Take aspirin to prevent a heart attack

Taking daily
aspirin might lower your chances of having a heart attack. Talk with your doctor before taking aspirin every day. To see if aspirin is right for you, you and your doctor will balance the benefits and the risks of taking a daily aspirin.

Preventing Another Heart Attack

After you've had a
heart attack, your biggest concern will probably be
that you could have another one. You can help lower your risk of another heart attack by joining a cardiac rehabilitation (rehab) program and taking your medicines.

Do cardiac rehab

You might have started cardiac rehab in the hospital or soon after you got home. It's an important part of your recovery after a heart attack.

In cardiac rehab, you will get education and support that help you make new, healthy habits,
such as eating right and getting more exercise.

Make heart-healthy habits

If you don't do a cardiac rehab program, you will still need to learn about
lifestyle changes that can lower your risk of another heart attack. These changes include quitting smoking, eating heart-healthy foods,
and being active.

Take your medicines

After having a heart attack, take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine, you might raise your risk of having another heart attack.

You might take medicines to:

Prevent blood clots. These medicines include aspirin and other medicines such as clopidogrel (Plavix).

"At some point in my life I
was going to have a heart attack. Smoking just sped it up. It happened while I
was playing basketball with some guys from work. I started getting pains in my
chest. The next thing I knew, I was on the floor."—Alan

Life After a Heart Attack

Coming home after a heart
attack may be unsettling. Your hospital stay may have seemed too short. You may
be nervous about being home without doctors and nurses after being so closely
watched in the hospital.

But you have had tests that tell your doctor that
it is safe for you to return home. Now that you're home, you can take steps to live a healthy lifestyle to reduce the chance of having another heart attack.

Do cardiac rehab

If you don't do a cardiac rehab program, you will still need to learn about
lifestyle changes that can lower your risk of another heart attack. These changes include quitting smoking, eating heart-healthy foods,
and being active. For more information on lifestyle changes, see Prevention.

Learn healthy habits

Making healthy
lifestyle changes can reduce your chance of another heart attack. Quitting
smoking, eating heart-healthy foods, getting regular
exercise, and staying at a healthy weight are important steps you can take.

Manage stress and get help for depression

Depression and heart disease are linked. People who have heart disease are more likely to get depressed. And if you have both depression and heart disease, you may not stay as healthy as possible. This can make depression and heart disease worse.

If you think you may have depression, talk to your doctor.

Stress and anger can also hurt your heart.
They might make your symptoms worse. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or
yoga.

Have sex when you're ready

You can resume sexual activity after a heart attack when you are healthy and feel ready for it. You could be ready if you can do mild or moderate activity, like brisk walking, without having angina symptoms. Talk with your doctor if you have any concerns. Your doctor can help you know if your heart is healthy enough for sex.

If you take
a nitrate, like nitroglycerin, do not take
erection-enhancing medicines. Combining a nitrate with one of these
medicines can cause a life-threatening drop in blood pressure.

Get support

Whether you are recovering from a heart attack or
are changing your lifestyle so you can avoid another one, emotional support from friends
and family is important. Think about joining a heart disease support group. Ask
your doctor about the types of support that are available where you live.
Cardiac rehab programs offer support for you and your family. Meeting other people with the same problems can help you know you're not alone.

Get a flu vaccine every year. It can help you stay healthy and may prevent another heart attack.

Drink alcohol in moderation, if you drink. This means having 1
alcoholic drink a day for women or 2 drinks a day for men.

Seek
help for sleep problems. Your doctor may want to check for
sleep apnea, a common sleep problem in people who have
heart disease. For more information, see the topic Sleep Apnea.

Medications

Take all of your medicines
correctly. Do not stop taking your medicine unless your doctor tells you to. Taking medicine can lower your risk of having another heart attack
or dying from coronary artery disease.

In the ambulance and emergency room

Treatment for a heart attack or unstable angina begins with medicines in the ambulance and emergency room. This treatment is similar for both. The goal is to prevent permanent heart muscle damage or prevent a heart attack by restoring blood flow to your
heart as quickly as possible.

In the hospital and at home

In the hospital, your doctors will start you on medicines that lower your risk of having complications or another heart attack. You may already have taken some of these medicines. They can help you live longer after a heart attack. You will take these medicines for a long time, maybe the rest of your life.

Medicine to manage angina symptoms

What to think about

If your doctor recommends daily aspirin, don't substitute
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil, for example) or naproxen (such as Aleve), for the aspirin. NSAIDS relieve pain and inflammation much like aspirin does, but they do not affect blood clotting in the same way that aspirin does. NSAIDs do not lower your risk of another heart attack. In fact, NSAIDs may raise your risk for a heart attack or stroke. Be safe with medicines. Read and follow all instructions on the label.

If you need to take an NSAID for a long time, such as for pain, talk with your doctor to see if it is safe for you. For more information about daily aspirin and NSAIDs, see Low-Dose Aspirin Therapy.

Surgery

An angioplasty procedure or bypass surgery might be done to open blocked arteries and improve blood flow to the heart.

Angioplasty

Angioplasty. This procedure gets blood flowing back to the heart. It opens a coronary artery that was narrowed or blocked during a heart attack. Doctors try to do angioplasty as soon as possible after a heart attack. Angioplasty might be done for unstable angina, especially if there is a high risk of a heart attack.

Angioplasty is not surgery. It is done using a thin,
soft tube called a catheter that's inserted in your artery. It doesn't use
large cuts (incisions) or require anesthesia to make you sleep.

But angioplasty is not done at all hospitals. Sometimes an ambulance will take a person to a hospital that provides angioplasty, even if that hospital is farther away. If a person is at a hospital that does not do angioplasty, he or she might be moved to another hospital where it is available.

If you are at a hospital that has proper
equipment and staff to do this procedure, you may have cardiac catheterization, also called coronary angiogram. Your doctor will
check your coronary arteries to see if angioplasty is right for you.

Bypass surgery

Bypass surgery. If angioplasty is not
right for you, emergency coronary artery bypass surgery may be done. For example, bypass surgery might be a better choice because of the location of the blockage or because you have many
blockages.

Cardiac rehabilitation

After you have had angioplasty or bypass
surgery, you may be encouraged to take part in a
cardiac rehabilitation program to help lower your risk
of death from heart disease. For more information, see the topic
Cardiac Rehabilitation.

Treatment for Complications

Heart attacks
that damage critical or large areas of the heart tend to cause more
problems (complications) later. If only a small amount of heart muscle dies, the heart may
still function normally after a heart attack.

The chance that these
complications will occur depends on the amount of heart tissue affected by a
heart attack and whether medicines are given during and after a heart attack to
help prevent these complications. Your age, general
health, and other things also affect your risk of complications and death.

About half of all people who
have a heart attack will have a serious complication. The kinds of
complications you may have depend upon the location and extent of the heart
muscle damage. The most common complications are:

Heart failure, which can be short-term or can become a
lifelong condition. Scar tissue
eventually replaces the areas of heart muscle that are damaged by a
heart attack. Scar tissue affects your heart's ability to pump as well as it should.
Damage to the
left ventricle can lead to
heart failure.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

Treatment for a
heart attack is increasingly successful at prolonging
life and reducing complications and hospitalization. But a heart attack can
lead to problems that get worse over time, such as
heart failure and abnormal heart rhythms (arrhythmias).

It can be hard to have talks with your
doctor and family about the end of your life. But making these decisions now
may bring you and your family peace of mind. Your family won't have to wonder
what you want. And you can spend your time focusing on your
relationships.

You will need to decide if you want
life-support measures if your health gets very bad. An
advance directive is a legal document that
tells doctors how to care for you at the end of your life.
You also can say where you want to have care. And you can name
someone who can make sure your wishes are followed.

Related Information

References

Other Works Consulted

Abraham NS, et al. (2010). ACCF/ACG/AHA 2010 Expert consensus statement on the concomitant use of proton pump inhibitors and thienopyridines: A focused update of the ACCF/ACG/AHA 2008 Expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Journal of the American College of Cardiology. Published online November 8, 2010 (doi:10.1016/j.jacc.2010.09.010).

Lichtman JH, et al. (2008). Depression and coronary
heart disease: Recommendations for screening, referral, and treatment: A
science advisory from the American Heart Association Prevention Committee of
the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council
on Epidemiology and Prevention, and Interdisciplinary Council on Quality of
Care and Outcomes Research: Endorsed by the American Psychiatric Association.
Circulation, 118(17): 1768–1775.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

Somers VK, et al. (2008). Sleep apnea and
cardiovascular disease: An American Heart Association/American College of
Cardiology Foundation Scientific Statement from the American Heart Association
Council for High Blood Pressure Research Professional Education Committee,
Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular
Nursing in collaboration with the National Heart, Lung, and Blood Institute
National Center on Sleep Disorders Research (National Institutes of Health).
Circulation, 118(10): 1080–1111.

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How this information was developed to help you make better health decisions.